Weigh background when dealing with patients

November 1, 2006

Dermatology patients represent a diverse population that spans a wide range of ages, ethnicities, cultural backgrounds and educational levels.

So how do dermatologists communicate to ensure that patients understand their diagnoses, prognoses and treatment plans?

Even dermatologists who consider their patient population to be primarily homogeneous acknowledge that age and cultural differences, and sometimes computer and health literacy, do impact communication.

"I would characterize my patients as 'prosumers,' " she says. "I have very few who haven't done all the homework on their condition and are ready for everything when they walk in the door."

Still, she faces challenges.

"I am struggling a bit with some subcultures," she says. "I've been seeing a lot of Asians and people from Thailand and Iran lately.

"To make sure we are communicating effectively, I'm just listening and learning from them about their families and their society. They'll tell me that cosmetic surgery is not really part of their culture, and they can't have a relative pick them up," she says, "so maybe we'll arrange for them to stay at a nearby hotel.

"But I don't know things unless I ask."

'Keep it simple'

In Mohave County, Ariz., David B. Roy, D.O., says his practice is also rather uniform, with skin cancer a primary diagnosis.

"The key is to keep what you say straightforward and simple," he says. "I always ask (patients) at the end of the consultation if they have any questions, and whether they understand what we're doing.

"We do have two big patient populations here: Hispanic and Caucasian. Really, the only thing we do is make sure there is no language barrier," he says. "If they don't speak English, or only broken English, we see if we have someone to translate for us. If we don't, we ask them to bring a family member who can translate."

Jany Sanchez, M.D., is a solo practitioner with offices in Miami and 35 miles south in Homestead, Fla. The Miami office serves a middle-class population; the Homestead area is largely populated by agricultural workers in the lower to middle socioeconomic strata.

"Language is important because we want to communicate, but depending on the cultural background, sometimes I have to involve the family a little more with the Hispanic population," Dr. Sanchez says. "That's something you have to weigh when you walk in the room and see a patient there with two or three family members, and they all have questions.

"On the other hand, some of my patients in the Homestead area are illiterate, so it actually takes a little more time to explain their condition to them," Dr. Sanchez says. "You really have to start from scratch."

A doctor can't just use a cookie-cutter approach, Dr. Sanchez says.

"You have to be a little more sensitive to the patient, and it takes more time than a straightforward office visit you read about in a textbook."